Success factors in the response to the Mpox epidemic in Guinea

Success factors in the response to the Mpox epidemic in Guinea | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Success factors in the response to the Mpox epidemic in Guinea Sory CONDE, Dimai Ouo KPAMY, Fatoumata CHERIF, Mohamed Lamine KOUROUMA, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7151834/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Guinea, like other West African countries, reported the emergence of MonkeyPox through its first recorded case in the forestland region. The objective of this research was to study the success factors in the response to the Mpox epidemic in Guinea. Method : This was a cross-sectional study with an analytical aim lasting three (03) months from May 1 to July 31, 2025, focusing on the actors involved in the response in Guinea. The data were collected using a structured questionnaire, and the analysis was carried out using Epi Infoversion 7 and Stataversion 13 software. The search for factors linked to the success of the response was carried out through a step-by-step retrograde multivariate analysis, and the significance threshold was set at 5%. Results : A total of 239 participantswere included, and theaverage age was38 years. Male participants(52%), nurses (67%) with a secondary education level (54%) and nurses working in the Macenta health district (42%) were the most represented. Regarding factors related to the health system, 95% of participants stated that the Community was informed and sensitized about the disease and about the presence of coordination teams and a rapid response team in 79% and 84%, respectively. A lack of vaccines (98%), medicines (98%) and laboratories (94%) was reported. There are isolation sites (59%) and normative documents (55% on average) with trained staff (96%), but these reports are insufficient (32%). According to multivariate analysis, after adjusting for the order ratio, the presence of a coordination team (OR = 25.4; 95% CI: 4.23–251), a rapid response team (OR = 35.5; 95% CI: 3.00–776), care staff (OR = 37.3; 95% CI: 3.45–611), monitoring staff (OR = 244; 95% CI: 3.49–50,932), an isolation site (OR = 8.28; 95% CI: 1.78–49.5), adapted equipment (OR = 18.5; 95% CI: 3.79–123), and care guides (OR = 86.2; 95% CI: 11.4–1242) were strongly associated with the success of the response to Mpox. Conclusion: The success of the Mpox response in Guinea relies on a functional and multisectoral organization. To ensure the sustainability of these gains, it is crucial to strengthen the coordination teams and regularly update the normative documents related to care and surveillance. Epidemiology Statistical Epidemiology Operations Research Success factors Response MonkeyPox Guinea 1. INTRODUCTION The emergence of a global health emergency requires rapid response and preventive measures to limit its spread at the national and international levels. The current increase in Monkeypox ( MPox ) cases in several regions of the world has led nations to adopt precautionary measures to avoid the negative impacts of this disease ( 1 ). It takes about 14 to 21 days for the symptoms of Mpox to disappear on their own. But its severity is variable and can range from mild to severe including symptoms like fever, headache, fatigue, muscle pain, lymphadenopathy, back pain and itchy or painful rashes that characterize the disease ( 2 ). And it is possible that complications occur which can lead to deaths ( 3 ). The initially pandemic epidemic in Africa was marked by the presence of two clades with notable epidemiological and clinical differences ( 4 ). There is a need for short-term emergency training to enable frontline health professionals to effectively diagnose and manage emerging cases while adopting adequate protective measures to reduce the risk of infections and virus transmission ( 1 ). Prevention of human-to-human transmission relies on early detection, case isolation, contact tracing and vaccine introduction to manage the current global epidemic ( 5 ). A comprehensive approach including vaccination, adequate supply of equipment, enhanced surveillance, rigorous disease control and cross-border cooperation at the international level is also essential. Public education also plays a key role by emphasizing the reduction of exposure risks through limiting sexual partners, avoiding contact with travelers from affected areas or with potential carrier animals and restricting travel to endemic areas ( 6 , 7 ). In the United States, 2,891 cases were reported between May and July 2022, 94% of which were associated with sexual intercourse with frequent genital and anal lesions but zero lethality ( 8 ). In Montreal, in October 2022, 402 cases of Mpox were reported with mainly sexual transmission, a median age of 37 years and no deaths thanks to rapid genomic surveillance and a targeted community response focused on rapid vaccination of at-risk individuals ( 9 ). In the UK, predominant sexual transmission and the presence of viral DNA in semen has been reported in several patients in 2022 ( 10 ). In Africa, MPOX is endemic in some countries, such as Nigeria, between 2017 and 2018; 122 cases were confirmed with a 39% hospitalization rate and a case fatality rate of 6%. The distribution of cases and contacts suggested primary zoonotic transmission and secondary human-to-human transmission. ( 11 ). Mpox cases after the cessation of smallpox vaccination campaigns was reported in 2010 with a lethality greater than 9% ( 12 ) . In Guinea, the Ebola resurgence in 2021 was quickly brought under control thanks to urgent in-depth mobilization and multi-sectoral coordination, despite the difficult context. Actions focused on the key pillars of the response made it possible to limit the spread and save lives ( 13 ). However, the first case of Mpox has been reported in the forest region since September 2024, but data on response strategies to this epidemic are very limited, hence the interest of this study. The objective of this research was to study the success factors in the response to the Mpox epidemic in Guinea. 2. METHOD 2.1. Framework of the study The Republic of Guinea served as the framework for this study. It is located in West Africa, is bordered by 300 km of coastline and extends more than 800 km from east to west and 500 km from north to south, for a total area of 245,857 km². In terms of health, the country has 33 districts plus the special region of the Conakry capital (05 districts). For the management of diseases with epidemic potential, including Mpox, treatment centers have been built throughout the country, and focal points posted in the health districts are responsible for directing all suspected cases to these CTEpi. The operation of these bodies is coordinated by the support department of the National Agency for Health Security (ANSS) through the Ministry of Health. 2.1. Type and duration of the study : This was a cross-sectional study with analytical aims lasting three (03) months from May 1 to July 31, 2025. 2.1. Study population : The study focused on the actors involved in the response in Guinea (ANSS, IRS, DPS, DG, DH, CTEpi and PTF). 2.3. Selection criteria: 2.3.1. The inclusion criteria for participants were as follows: all participants involved in the study in Guinea (ANSS, IRS, DPS, DG, DH, CTEpi and PTF) who agreed to participate in the study with verbal consent. 2.3.2. The inclusion criteria for participants were as follows: not included in this study; not involved in the study; not involved in the response to the Mpox epidemic; and/or lacked knowledge of the epidemic response in Guinea. 2.4. Recruitment method: We carried out an exhaustive recruitment of all the actors involved in the response in Guinea (ANSS, IRS, DPS, DG, DH, CTEpi and PTF) who met our selection criteria. 2.5. Study variables: Dependent variable: This variable was " success of the response ". It was a dichotomous variable (yes/no). The presence of all success factors was checked by yes or one (1), and their absence was checked by no or zero (0). Independent variables: Care guide, existence of surveillance guide, existence of risk communication guide, existence of response fund, existence of care staff, existence of surveillance staff, existence of isolation site, existence of medication, existence of equipment, existence of rolling logistics, existence of analysis laboratory, virus serotyping, circulating glade, time taken before hospitalization, clinical characteristics, age, personal hygiene, presence of comorbidity, vaccination status, information/community awareness, correct application of Care guide, correct application of surveillance guide, correct application of risk communication guide, rendering of results, existence of coordination team, and existence of rapid intervention team. 2.6. Statistical analysis tools The analysis was carried out using Epi Info version 7 and Stata version 13 software. For qualitative variables, the numbers and percentages were calculated, and those for quantitative variables were expressed as the mean and standard deviation. The search for factors related to the success of the response was carried out through a step-by-step retrograde multivariate analysis and consisted of crossing this variable with the independent variables mentioned above. All variables associated with the 5% threshold were retained as factors related to the success of the response. 3. RESULTS Of the 239 participants, the majority were employed in the Macenta health district (42%), with an average age of 38 years. There were 52% men and 48% women. Married participants (82%), those with a secondary education (54%) and those with a university education (42%) were the most common (Table I).' The descriptive part of the resources and response capacities highlights a strong awareness of the population, with 95% of the participants having affirmed that the population was informed and sensitized about the Mpox and the presence of a coordination team (79%) and rapid intervention (84%). On the other hand, there is a cruel lack of material and financial resources characterized by an almost total absence of funds (98%), vaccines (98%), medication (98%) and laboratory (94%). The existence of isolation sites (59%) and normative documents (55% on average) was reported, and despite the training of almost all the staff (96%), 32% of the participants considered their number insufficient (Table II). Regarding patient characteristics, the reported cases of Mpox involved mostly young subjects with a median age of 18 years (ranging from 15 to 28 years). Clade II was the most common, accounting for 75% of the reported cases. Regarding comorbidities, 6.3% of participants reported the existence of comorbidities in patients with Mpox, with HIV accounting for 60% of the patients (see Table III). According to multivariate analysis, after adjusting for the order ratio, the presence of a coordination team (OR = 25.4; 95% CI: 4.23–251), a rapid response team (OR = 35.5; 95% CI: 3.00–776), care staff (OR = 37.3; 95% CI: 3.45–611), monitoring staff (OR = 244; 95% CI: 3.49–50,932), an isolation site (OR = 8.28; 95% CI: 1.78–49.5), adapted equipment (OR = 18.5; 95% CI: 3.79–123), and care guides (OR = 86.2; 95% CI: 11.4–1242) were strongly associated with the success of the response to Mpox (see Table IV) 4. DISCUSSION The success of the response to the Mpox epidemic depends on the capacity of local health systems to rapidly coordinate interventions and mobilize resources. We conducted this cross-sectional study with the aim of identifying the success factors of the response to this epidemic in Guinea. Several studies highlight that the effectiveness of health responses depends on the availability of structured coordination teams, rapid interventions and human resources trained in surveillance and case management ( 14 , 15 ) . In our series, the profile of response actors was dominated by young subjects with a secondary education and nurses. Health personnel, particularly nurses, occupy an essential place in the prevention and control of epidemics within hospitals and clinics worldwide ( 6 ). Our result highlights the need for targeted strengthening of surveillance and care skills of response personnel. Almost all of our respondents believed that the population was informed about the existence of the disease, thus reflecting an effective communication strategy. According to the literature, early detection and management of epidemics can be optimized through community surveillance by mobilizing community members to ensure local health monitoring ( 16 ). A European series argues that emergency management is based on an essential pillar which is composed of risk communication, community engagement and infodemic management ( 17 ). Through this communication, we could have community mobilization which is essential for the effective management of an epidemic through early detection of cases, acceptability of public health measures and reduction of stigma. Clinically, affected subjects were young and clade II was predominantly reported. HIV was the most common co-infection. According to data from 16 countries between April and June 2022; 41% of patients were infected with HIV with a median age of 38 years ( 18 ). The circulation of clade II in the West African region is supported by the literature as being the form responsible for epidemic outbreaks in this region ( 19 ) . In this study, multivariate analysis reveals that the presence of a coordination team, rapid intervention, surveillance and management are significantly associated with the success of the response. Our result is supported by data from a systematic review calling for strengthened international support for surveillance so that the detection of Mpox cases is fundamental to monitor the evolution of the dynamics of the epidemiology of this re-emerging disease. ( 20 ). This demonstrates that the performance factors of a response depend on the capacity of the country's health system to organize and quickly deploy human and material resources. In addition to these strengths reported above, our study highlighted major deficiencies in the response sector focused on the lack of vaccines against Mpox, drugs for management as well as the absence of adequate laboratory for the analysis of samples in the majority of prefectures. However, the literature recommends in public health strategies to integrate the strengthening of health infrastructures, to improve surveillance systems, to guarantee equitable access to vaccines and treatments ( 21 ). These identified deficiencies can compromise the capacity to effectively diagnose, treat and prevent new cases. The existence of an isolation site, suitable equipment and, above all, standardized management guides were also associated with the effectiveness of the response. Our result is supported by the fact that isolating cases upon detection, in appropriate sites, significantly reduces transmission ( 22 ). Hence the interest in having a clear and available regulatory framework with adequate infrastructure to contain the disease. Our study also reported that the majority of staff reported having been trained, but that the number was insufficient. This is in contrast to a Turkish series reporting that up to 95.8% of nurses had not received any specific training on MPOX. ( 23 ). Thus justifying the crucial need to strengthen these human resources to balance the tension between the technical capacities of the staff and its volume. One limitation of this study is that it is cross-sectional and based on declarative data susceptible to memory bias and social desirability, despite which it provides a relevant and contextual basis for strengthening Mpox response strategies in resource-limited settings. CONCLUSION This study highlights the critical importance of a responsive health system built around functional coordination with trained human resources and available logistical resources. The identified gaps are dominated by difficulties accessing vaccines, specific drugs, and diagnostic laboratory capacity. The success of the MPOX response in Guinea relies on a functional and multisectoral organization. Strengthening coordination teams and tools, management protocols, and surveillance is an essential lever for containing this epidemic. Declarations Ethical Approval and Consent to Participate The study received approval from the National Ethics Committee for Health Research; Data collection authorization was granted by the General Directorate of the National Health Security Agency; An information note was provided to participants, and their consent was obtained before administering the questionnaire. Anonymity and confidentiality were ensured throughout the data collection and analysis process. Consent for Publication The manuscript does not contain any identifiable personal data, so no specific consent for publication is required. Availability of Data and Materials The data generated and/or analyzed during this study are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no competing interests. Funding No specific funding is mentioned in the article. Authors' contributions KPAMY Dimaï Ouo, Mohamed Lamine KOUROUMA and Gbawa CAMARA: Writing the protocol, data collection, manuscript writing, and table presentation; CONDE Sory and CHERIF Fatoumata : Review and revision of the protocol and manuscript. ACKNOWLEDGEMENTS The authors express their gratitude to all the actors involved in the epidemic response in Guinea, particularly the agents of the CTEPIs, the prefectural health directorates, regional health inspections, and partners, for their active contribution to this study. Sincere thanks to the West African Health Organization (WAHO) for all the support in conducting this study. A special thank you is extended to the General Directorate of the National Health Security Agency for their valuable support. References Ahmed SK, Omar RM, Hussein SH, Ahmed NA, Abdulqadir SO, Essa RA et al (2022) Middle East countries preparedness for Monkeypox outbreak: A call to action. Int J Surg Oct 106:106948 Ahmed SK, Abdulqadir SO, Omar RM, Abdullah AJ, Rahman HA, Hussein SH et al (2023) Knowledge, Attitude and Worry in the Kurdistan Region of Iraq during the Mpox (Monkeypox) Outbreak in 2022: An Online Cross-Sectional Study. Vaccines Mar 8(3):610 Ophinni Y, Frediansyah A, Sirinam S, Megawati D, Stoian AM, Enitan SS et al (2022) Monkeypox: Immune response, vaccination and preventive efforts. Narra J [Internet]. Oct 22, [cited July 16, 2025];2(3). Available at: https://narraj.org/main/article/view/90 Likos AM, Sammons SA, Olson VA, Frace AM, Li Y, Olsen-Rasmussen M et al (2005) A tale of two clades: monkeypox viruses. J Gen Virol 86(10):2661–2672 Bogacka A, Wroczynska A, Rymer W, Grzesiowski P, Kant R, Grzybek M et al (2025) Mpox unveiled: Global epidemiology, treatment advances, and prevention strategies. One Health 10 Apr 20:101030 Ahmed SK, El-Kader RGA, Lorenzo JM, Chakraborty C, Dhama K, Mohammed MG et al (2023) Hospital-based salient prevention and control measures to counteract the 2022 monkeypox outbreak. Health Sci Rep Jan 6(1):e1057 Ren SY, Li J, Gao RD (2022) Monkeypox outbreak: Why is it a public health emergency of international concern? What can we do to control it? World J Clin Cases. 26 Oct 2022;10(30):10873–81 Philpott D, Hughes CM, Alroy KA, Kerins JL, Pavlick J, Asbel L et al (2022) Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022. MMWR Morb Mortal Wkly Rep Aug 12(32):1018–1022 Harrison LB, Bergeron G, Cadieux G, Charest H, Fafard J, Levade I et al (Jan 2023) Monkeypox in Montreal: Epidemiology, Phylogenomics, and Public Health Response to a Large North American Outbreak. Ann Intern Med 176(1):67–76 Lapa D, Carletti F, Mazzotta V, Matusali G, Pinnetti C, Meschi S et al (2022) Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. Lancet Infect Dis Sep 22(9):1267–1269 Yinka-Ogunleye A, Aruna O, Dalhat M, Ogoina D, McCollum A, Disu Y et al (2019) Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. Lancet Infect Dis August 19(8):872–879 Rimoin AW, Mulembakani PM, Johnston SC, Lloyd Smith JO, Kisalu NK, Kinkela TL et al (2010) Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo. Proc Natl Acad Sci 14 Sep 107(37):16262–16267 WHO Ebola virus disease – Guinea [Internet]. [cited 16 July 2025]. Available at: https://www.who.int/en/emergencies/disease-outbreak-news/item/2021-DON328 World Health Organization Regional Office for the Eastern Mediterranean, Al-Mandhari A, Kodama C, Abubakar A, Hajjeh R, Brennan R (2022) Monkeypox outbreak and response efforts in the Eastern Mediterranean Region. East Mediterr Health J Jul 30(7):465–468 Olawade DB, Wada OZ, Fidelis SC, Oluwole OS, Alisi CS, Orimabuyaku NF et al (2024) Strengthening Africa's response to Mpox (monkeypox): insights from historical outbreaks and the present global spread. Sci One Health Jan 1:3:100085 McGowan CR, Takahashi E, Romig L, Bertram K, Kadir A, Cummings R et al (2022) Community-based surveillance of infectious diseases: a systematic review of drivers of success. BMJ Glob Health August 7(8):e009934 Kutalek R, Grohma P, Maukner AC, Wojczewski S, Palumbo L, Salvi C (2025) The role of RCCE-IM in the mpox response: A qualitative reflection process with experts and civil society in three European countries. J Infect Public Health Jul 18(7):102787 Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB et al (2022) Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med 25 Aug 387(8):679–691 Sah R, Apostolopoulos V, Mehta R, Rohilla R, Sah S, Mohanty A et al (2024) Mpox strikes once more in 2024: Declared again as a public health emergency of international concern. Travel Med Infect Dis Sep 1:61:102753 Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR et al (2022) The changing epidemiology of human monkeypox—A potential threat? A systematic review. Gromowski G, editor. PLoS Negl Too Say. Feb 11, ;16(2):e0010141 Olawade DB, Wada OZ, Fidelis SC, Oluwole OS, Alisi CS, Orimabuyaku NF et al (2024) Strengthening Africa's response to Mpox (monkeypox): insights from historical outbreaks and the present global spread. Sci One Health Jan 1:3:100085 Jeong YD, Hart WS, Thompson RN, Ishikane M, Nishiyama T, Park H et al (2024) Modeling the effectiveness of an isolation strategy for managing mpox outbreaks with variable infectiousness profiles. Nat Commun 26 Aug 15(1):7112 Kocatepe V, Yildirim D, Türkmenoğlu A (2025) Evaluation of nurses' perception of monkeypox in terms of epidemic anxiety, stress levels and compliance with isolation measures. BMC Nurs Jul 8:24:878 Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7151834","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":487068582,"identity":"0bb57cd9-0234-4620-81fc-e9eb09769e5c","order_by":0,"name":"Sory CONDE","email":"","orcid":"","institution":"National Health Security Agency of Guinea","correspondingAuthor":false,"prefix":"","firstName":"Sory","middleName":"","lastName":"CONDE","suffix":""},{"id":487068583,"identity":"b3381719-8cae-4067-b96d-8601bc180e42","order_by":1,"name":"Dimai Ouo KPAMY","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYDCCw0CcAMT8IE5CASlaJBtADANitByA0gZgBjFa+I5zJ354UHFYzvj8aiDDgEGeX+wAfi2Sh3k3SyScOWxsduMtkGHAYDhzdgJ+LQaHeTdIJLYdTtx24+wGkJYEg9uEtWz+AdKyecbZzT+I1bINbMsG/t5txNkC9Ms2i4Qz6cYSN0AMAwnCfuE7f3bzzR8V1nL8/WCGjTy/NAEtCCABVilBrHIQ4D9AiupRMApGwSgYSQAAyUZIrkupXogAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-0535-4572","institution":"Faculty of Health Sciences and Technology, Gamal Abdel Nasser University of Conakry","correspondingAuthor":true,"prefix":"","firstName":"Dimai","middleName":"Ouo","lastName":"KPAMY","suffix":""},{"id":487068584,"identity":"aac9bd31-e9c6-48f2-a81c-4c44ed24f20e","order_by":2,"name":"Fatoumata CHERIF","email":"","orcid":"","institution":"National Health Security Agency of Guinea","correspondingAuthor":false,"prefix":"","firstName":"Fatoumata","middleName":"","lastName":"CHERIF","suffix":""},{"id":487068585,"identity":"b04f8dde-d4c7-4cca-90f3-3ea13e2cda99","order_by":3,"name":"Mohamed Lamine KOUROUMA","email":"","orcid":"","institution":"National Health Security Agency of Guinea","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Lamine","lastName":"KOUROUMA","suffix":""},{"id":487068586,"identity":"1ab72395-7148-4a20-8a6a-697f75931908","order_by":4,"name":"Gbawa CAMARA","email":"","orcid":"","institution":"National Health Security Agency of Guinea","correspondingAuthor":false,"prefix":"","firstName":"Gbawa","middleName":"","lastName":"CAMARA","suffix":""}],"badges":[],"createdAt":"2025-07-17 19:17:13","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7151834/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7151834/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87995398,"identity":"08ec5da6-c0ee-49f4-8b0a-1fa47ebeea70","added_by":"auto","created_at":"2025-07-31 09:18:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":406619,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7151834/v1/26177408-c7da-45d7-b634-1f40f060afaf.pdf"},{"id":87994156,"identity":"c8dd559e-af46-41a3-bac2-f7169e99d079","added_by":"auto","created_at":"2025-07-31 09:02:38","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26685,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7151834/v1/650c726d0d3fc4307e0470b9.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSuccess factors in the response to the Mpox epidemic in Guinea\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eThe emergence of a global health emergency requires rapid response and preventive measures to limit its spread at the national and international levels. The current increase in Monkeypox ( MPox ) cases in several regions of the world has led nations to adopt precautionary measures to avoid the negative impacts of this disease (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It takes about 14 to 21 days for the symptoms of Mpox to disappear on their own. But its severity is variable and can range from mild to severe including symptoms like fever, headache, fatigue, muscle pain, lymphadenopathy, back pain and itchy or painful rashes that characterize the disease (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). And it is possible that complications occur which can lead to deaths (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The initially pandemic epidemic in Africa was marked by the presence of two clades with notable epidemiological and clinical differences (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). There is a need for short-term emergency training to enable frontline health professionals to effectively diagnose and manage emerging cases while adopting adequate protective measures to reduce the risk of infections and virus transmission (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Prevention of human-to-human transmission relies on early detection, case isolation, contact tracing and vaccine introduction to manage the current global epidemic (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). A comprehensive approach including vaccination, adequate supply of equipment, enhanced surveillance, rigorous disease control and cross-border cooperation at the international level is also essential. Public education also plays a key role by emphasizing the reduction of exposure risks through limiting sexual partners, avoiding contact with travelers from affected areas or with potential carrier animals and restricting travel to endemic areas (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In the United States, 2,891 cases were reported between May and July 2022, 94% of which were associated with sexual intercourse with frequent genital and anal lesions but zero lethality (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In Montreal, in October 2022, 402 cases of Mpox were reported with mainly sexual transmission, a median age of 37 years and no deaths thanks to rapid genomic surveillance and a targeted community response focused on rapid vaccination of at-risk individuals (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In the UK, predominant sexual transmission and the presence of viral DNA in semen has been reported in several patients in 2022 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In Africa, MPOX is endemic in some countries, such as Nigeria, between 2017 and 2018; 122 cases were confirmed with a 39% hospitalization rate and a case fatality rate of 6%. The distribution of cases and contacts suggested primary zoonotic transmission and secondary human-to-human transmission. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Mpox cases after the cessation of smallpox vaccination campaigns was reported in 2010 with a lethality greater than 9% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eIn Guinea, the Ebola resurgence in 2021 was quickly brought under control thanks to urgent in-depth mobilization and multi-sectoral coordination, despite the difficult context. Actions focused on the key pillars of the response made it possible to limit the spread and save lives (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, the first case of Mpox has been reported in the forest region since September 2024, but data on response strategies to this epidemic are very limited, hence the interest of this study. The objective of this research was to study the success factors in the response to the Mpox epidemic in Guinea.\u003c/p\u003e"},{"header":"2. METHOD","content":"\u003cp\u003e\u003cstrong\u003e2.1. Framework of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Republic of Guinea served as the framework for this study. It is located in West Africa, is bordered by 300 km of coastline and extends more than 800 km from east to west and 500 km from north to south, for a total area of 245,857 km\u0026sup2;. In terms of health, the country has 33 districts plus the special region of the Conakry capital (05 districts). For the management of diseases with epidemic potential, including Mpox, treatment centers have been built throughout the country, and focal points posted in the health districts are responsible for directing all suspected cases to these CTEpi. The operation of these bodies is coordinated by the support department of the National Agency for Health Security (ANSS) through the Ministry of Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1. Type and duration of the study\u003c/strong\u003e: This was a cross-sectional study with analytical aims lasting three (03) months from May 1 \u003csup\u003eto\u0026nbsp;\u003c/sup\u003eJuly 31, 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1. Study population\u003c/strong\u003e: The study focused on the actors involved in the response in Guinea (ANSS, IRS, DPS, DG, DH, CTEpi and PTF).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Selection criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2.3.1. \u0026nbsp; The inclusion criteria for participants were as follows: all participants involved in the study in Guinea (ANSS, IRS, DPS, DG, DH, CTEpi and PTF) who agreed to participate in the study with verbal consent.\u003c/p\u003e\n\u003cp\u003e2.3.2. \u0026nbsp; The inclusion criteria for participants were as follows: not included in this study; not involved in the study; not involved in the response to the Mpox epidemic; and/or lacked knowledge of the epidemic response in Guinea.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.\u0026nbsp;\u003c/strong\u003eRecruitment method:\u003c/p\u003e\n\u003cp\u003eWe carried out an exhaustive recruitment of all the actors involved in the response in Guinea (ANSS, IRS, DPS, DG, DH, CTEpi and PTF) who met our selection criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStudy variables:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variable:\u0026nbsp;\u003c/strong\u003eThis variable was \u0026quot;\u003cstrong\u003esuccess\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of the response\u003c/strong\u003e\u0026quot;. It was a dichotomous variable (yes/no). The presence of all success factors was checked by yes or one (1), and their absence was checked by no or zero (0).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables:\u0026nbsp;\u003c/strong\u003eCare guide, existence of surveillance guide, existence of risk communication guide, existence of response fund, existence of care staff, existence of surveillance staff, existence of isolation site, existence of medication, existence of equipment, existence of rolling logistics, existence of analysis laboratory, virus serotyping, circulating glade, time taken before hospitalization, clinical characteristics, age, personal hygiene, presence of comorbidity, vaccination status, information/community awareness, correct application of Care guide, correct application of surveillance guide, correct application of risk communication guide, rendering of results, existence of coordination team, and existence of rapid intervention team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6. Statistical analysis tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis was carried out using Epi Info version 7 and Stata version 13 software. For qualitative variables, the numbers and percentages were calculated, and those for quantitative variables were expressed as the mean and standard deviation.\u003c/p\u003e\n\u003cp\u003eThe search for factors related to the success of the response was carried out through a step-by-step retrograde multivariate analysis and consisted of crossing this variable with the independent variables mentioned above. All variables associated with the 5% threshold were retained as factors related to the success of the response.\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eOf the 239 participants, the majority were employed in the Macenta health district (42%), with an average age of 38 years. There were 52% men and 48% women. Married participants (82%), those with a secondary education (54%) and those with a university education (42%) were the most common (Table I).\u0026apos;\u003c/p\u003e\n\u003cp\u003eThe descriptive part of the resources and response capacities highlights a strong awareness of the population, with 95% of the participants having affirmed that the population was informed and sensitized about the Mpox and the presence of a coordination team (79%) and rapid intervention (84%). On the other hand, there is a cruel lack of material and financial resources characterized by an almost total absence of funds (98%), vaccines (98%), medication (98%) and laboratory (94%). The existence of isolation sites (59%) and normative documents (55% on average) was reported, and despite the training of almost all the staff (96%), 32% of the participants considered their number insufficient (Table II).\u003c/p\u003e\n\u003cp\u003eRegarding patient characteristics, the reported cases of Mpox involved mostly young subjects with a median age of 18 years (ranging from 15 to 28 years). Clade II was the most common, accounting for 75% of the reported cases. Regarding comorbidities, 6.3% of participants reported the existence of comorbidities in patients with Mpox, with HIV accounting for 60% of the patients (see Table III).\u003c/p\u003e\n\u003cp\u003eAccording to multivariate analysis, after adjusting for the order ratio, the presence of a coordination team (OR = 25.4; 95% CI: 4.23\u0026ndash;251), a rapid response team (OR = 35.5; 95% CI: 3.00\u0026ndash;776), care staff (OR = 37.3; 95% CI: 3.45\u0026ndash;611), monitoring staff (OR = 244; 95% CI: 3.49\u0026ndash;50,932), an isolation site (OR = 8.28; 95% CI: 1.78\u0026ndash;49.5), adapted equipment (OR = 18.5; 95% CI: 3.79\u0026ndash;123), and care guides (OR = 86.2; 95% CI: 11.4\u0026ndash;1242) were strongly associated with the success of the response to Mpox (see Table IV)\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThe success of the response to the Mpox epidemic depends on the capacity of local health systems to rapidly coordinate interventions and mobilize resources. We conducted this cross-sectional study with the aim of identifying the success factors of the response to this epidemic in Guinea. Several studies highlight that the effectiveness of health responses depends on the availability of structured coordination teams, rapid interventions and human resources trained in surveillance and case management (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eIn our series, the profile of response actors was dominated by young subjects with a secondary education and nurses. Health personnel, particularly nurses, occupy an essential place in the prevention and control of epidemics within hospitals and clinics worldwide (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Our result highlights the need for targeted strengthening of surveillance and care skills of response personnel.\u003c/p\u003e\u003cp\u003eAlmost all of our respondents believed that the population was informed about the existence of the disease, thus reflecting an effective communication strategy. According to the literature, early detection and management of epidemics can be optimized through community surveillance by mobilizing community members to ensure local health monitoring (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A European series argues that emergency management is based on an essential pillar which is composed of risk communication, community engagement and infodemic management (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Through this communication, we could have community mobilization which is essential for the effective management of an epidemic through early detection of cases, acceptability of public health measures and reduction of stigma.\u003c/p\u003e\u003cp\u003eClinically, affected subjects were young and clade II was predominantly reported. HIV was the most common co-infection. According to data from 16 countries between April and June 2022; 41% of patients were infected with HIV with a median age of 38 years (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The circulation of clade II in the West African region is supported by the literature as being the form responsible for epidemic outbreaks in this region (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eIn this study, multivariate analysis reveals that the presence of a coordination team, rapid intervention, surveillance and management are significantly associated with the success of the response. Our result is supported by data from a systematic review calling for strengthened international support for surveillance so that the detection of Mpox cases is fundamental to monitor the evolution of the dynamics of the epidemiology of this re-emerging disease. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This demonstrates that the performance factors of a response depend on the capacity of the country's health system to organize and quickly deploy human and material resources.\u003c/p\u003e\u003cp\u003eIn addition to these strengths reported above, our study highlighted major deficiencies in the response sector focused on the lack of vaccines against Mpox, drugs for management as well as the absence of adequate laboratory for the analysis of samples in the majority of prefectures. However, the literature recommends in public health strategies to integrate the strengthening of health infrastructures, to improve surveillance systems, to guarantee equitable access to vaccines and treatments (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). These identified deficiencies can compromise the capacity to effectively diagnose, treat and prevent new cases.\u003c/p\u003e\u003cp\u003eThe existence of an isolation site, suitable equipment and, above all, standardized management guides were also associated with the effectiveness of the response. Our result is supported by the fact that isolating cases upon detection, in appropriate sites, significantly reduces transmission (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Hence the interest in having a clear and available regulatory framework with adequate infrastructure to contain the disease.\u003c/p\u003e\u003cp\u003eOur study also reported that the majority of staff reported having been trained, but that the number was insufficient. This is in contrast to a Turkish series reporting that up to 95.8% of nurses had not received any specific training on MPOX. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Thus justifying the crucial need to strengthen these human resources to balance the tension between the technical capacities of the staff and its volume.\u003c/p\u003e\u003cp\u003eOne limitation of this study is that it is cross-sectional and based on declarative data susceptible to memory bias and social desirability, despite which it provides a relevant and contextual basis for strengthening Mpox response strategies in resource-limited settings.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study highlights the critical importance of a responsive health system built around functional coordination with trained human resources and available logistical resources. The identified gaps are dominated by difficulties accessing vaccines, specific drugs, and diagnostic laboratory capacity. The success of the MPOX response in Guinea relies on a functional and multisectoral organization. Strengthening coordination teams and tools, management protocols, and surveillance is an essential lever for containing this epidemic.\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthical Approval and Consent to Participate\u003cul\u003e\n \u003cli\u003eThe study received approval from the National Ethics Committee for Health Research;\u003c/li\u003e\n \u003cli\u003eData collection authorization was granted by the General Directorate of the National Health Security Agency;\u003c/li\u003e\n \u003cli\u003eAn information note was provided to participants, and their consent was obtained before administering the questionnaire. Anonymity and confidentiality were ensured throughout the data collection and analysis process.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eConsent for Publication\u003cul\u003e\n \u003cli\u003eThe manuscript does not contain any identifiable personal data, so no specific consent for publication is required.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eAvailability of Data and Materials\u003cul\u003e\n \u003cli\u003eThe data generated and/or analyzed during this study are available from the corresponding author upon reasonable request.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eCompeting Interests\u003cul\u003e\n \u003cli\u003eThe authors declare that they have no competing interests.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eFunding\u003cul\u003e\n \u003cli\u003eNo specific funding is mentioned in the article.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eAuthors\u0026apos; contributions\u003cul\u003e\n \u003cli\u003eKPAMY Dima\u0026iuml; Ouo, Mohamed Lamine KOUROUMA and Gbawa CAMARA: Writing the protocol, data collection, manuscript writing, and table presentation;\u003c/li\u003e\n \u003cli\u003eCONDE Sory and CHERIF Fatoumata : Review and revision of the protocol and manuscript.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe authors express their gratitude to all the actors involved in the epidemic response in Guinea, particularly the agents of the CTEPIs, the prefectural health directorates, regional health inspections, and partners, for their active contribution to this study.\u003c/li\u003e\n \u003cli\u003eSincere thanks to the West African Health Organization (WAHO) for all the support in conducting this study.\u003c/li\u003e\n \u003cli\u003eA special thank you is extended to the General Directorate of the National Health Security Agency for their valuable support.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAhmed SK, Omar RM, Hussein SH, Ahmed NA, Abdulqadir SO, Essa RA et al (2022) Middle East countries preparedness for Monkeypox outbreak: A call to action. Int J Surg Oct 106:106948\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed SK, Abdulqadir SO, Omar RM, Abdullah AJ, Rahman HA, Hussein SH et al (2023) Knowledge, Attitude and Worry in the Kurdistan Region of Iraq during the Mpox (Monkeypox) Outbreak in 2022: An Online Cross-Sectional Study. Vaccines Mar 8(3):610\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOphinni Y, Frediansyah A, Sirinam S, Megawati D, Stoian AM, Enitan SS et al (2022) Monkeypox: Immune response, vaccination and preventive efforts. Narra J [Internet]. Oct 22, [cited July 16, 2025];2(3). 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One Health 10 Apr 20:101030\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed SK, El-Kader RGA, Lorenzo JM, Chakraborty C, Dhama K, Mohammed MG et al (2023) Hospital-based salient prevention and control measures to counteract the 2022 monkeypox outbreak. Health Sci Rep Jan 6(1):e1057\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRen SY, Li J, Gao RD (2022) Monkeypox outbreak: Why is it a public health emergency of international concern? What can we do to control it? World J Clin Cases. 26 Oct 2022;10(30):10873\u0026ndash;81\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePhilpott D, Hughes CM, Alroy KA, Kerins JL, Pavlick J, Asbel L et al (2022) Epidemiologic and Clinical Characteristics of Monkeypox Cases \u0026mdash; United States, May 17\u0026ndash;July 22, 2022. MMWR Morb Mortal Wkly Rep Aug 12(32):1018\u0026ndash;1022\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarrison LB, Bergeron G, Cadieux G, Charest H, Fafard J, Levade I et al (Jan 2023) Monkeypox in Montreal: Epidemiology, Phylogenomics, and Public Health Response to a Large North American Outbreak. Ann Intern Med 176(1):67\u0026ndash;76\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLapa D, Carletti F, Mazzotta V, Matusali G, Pinnetti C, Meschi S et al (2022) Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. Lancet Infect Dis Sep 22(9):1267\u0026ndash;1269\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYinka-Ogunleye A, Aruna O, Dalhat M, Ogoina D, McCollum A, Disu Y et al (2019) Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. Lancet Infect Dis August 19(8):872\u0026ndash;879\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRimoin AW, Mulembakani PM, Johnston SC, Lloyd Smith JO, Kisalu NK, Kinkela TL et al (2010) Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo. Proc Natl Acad Sci 14 Sep 107(37):16262\u0026ndash;16267\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO Ebola virus disease \u0026ndash; Guinea [Internet]. [cited 16 July 2025]. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/en/emergencies/disease-outbreak-news/item/2021-DON328\u003c/span\u003e\u003cspan address=\"https://www.who.int/en/emergencies/disease-outbreak-news/item/2021-DON328\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization Regional Office for the Eastern Mediterranean, Al-Mandhari A, Kodama C, Abubakar A, Hajjeh R, Brennan R (2022) Monkeypox outbreak and response efforts in the Eastern Mediterranean Region. East Mediterr Health J Jul 30(7):465\u0026ndash;468\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlawade DB, Wada OZ, Fidelis SC, Oluwole OS, Alisi CS, Orimabuyaku NF et al (2024) Strengthening Africa's response to Mpox (monkeypox): insights from historical outbreaks and the present global spread. Sci One Health Jan 1:3:100085\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcGowan CR, Takahashi E, Romig L, Bertram K, Kadir A, Cummings R et al (2022) Community-based surveillance of infectious diseases: a systematic review of drivers of success. BMJ Glob Health August 7(8):e009934\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKutalek R, Grohma P, Maukner AC, Wojczewski S, Palumbo L, Salvi C (2025) The role of RCCE-IM in the mpox response: A qualitative reflection process with experts and civil society in three European countries. J Infect Public Health Jul 18(7):102787\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB et al (2022) Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med 25 Aug 387(8):679\u0026ndash;691\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSah R, Apostolopoulos V, Mehta R, Rohilla R, Sah S, Mohanty A et al (2024) Mpox strikes once more in 2024: Declared again as a public health emergency of international concern. Travel Med Infect Dis Sep 1:61:102753\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR et al (2022) The changing epidemiology of human monkeypox\u0026mdash;A potential threat? A systematic review. Gromowski G, editor. PLoS Negl Too Say. Feb 11, ;16(2):e0010141\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlawade DB, Wada OZ, Fidelis SC, Oluwole OS, Alisi CS, Orimabuyaku NF et al (2024) Strengthening Africa's response to Mpox (monkeypox): insights from historical outbreaks and the present global spread. Sci One Health Jan 1:3:100085\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJeong YD, Hart WS, Thompson RN, Ishikane M, Nishiyama T, Park H et al (2024) Modeling the effectiveness of an isolation strategy for managing mpox outbreaks with variable infectiousness profiles. Nat Commun 26 Aug 15(1):7112\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKocatepe V, Yildirim D, T\u0026uuml;rkmenoğlu A (2025) Evaluation of nurses' perception of monkeypox in terms of epidemic anxiety, stress levels and compliance with isolation measures. BMC Nurs Jul 8:24:878\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"National Health Security Agency of Guinea","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Success factors, Response, MonkeyPox, Guinea","lastPublishedDoi":"10.21203/rs.3.rs-7151834/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7151834/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Guinea, like other West African countries, reported the emergence of MonkeyPox through its first recorded case in the forestland region. The objective of this research was to study the success factors in the response to the Mpox epidemic in Guinea.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: This was a cross-sectional study with an analytical aim lasting three (03) months from May 1 to July 31, 2025, focusing on the actors involved in the response in Guinea. The data were collected using a structured questionnaire, and the analysis was carried out using Epi Infoversion 7 and Stataversion 13 software. The search for factors linked to the success of the response was carried out through a step-by-step retrograde multivariate analysis, and the significance threshold was set at 5%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 239 participantswere included, and theaverage age was38 years. Male participants(52%), nurses (67%) with a secondary education level (54%) and nurses working in the Macenta health district (42%) were the most represented. Regarding factors related to the health system, 95% of participants stated that the Community was informed and sensitized about the disease and about the presence of coordination teams and a rapid response team in 79% and 84%, respectively. A lack of vaccines (98%), medicines (98%) and laboratories (94%) was reported. There are isolation sites (59%) and normative documents (55% on average) with trained staff (96%), but these reports are insufficient (32%). According to multivariate analysis, after adjusting for the order ratio, the presence of a coordination team (OR = 25.4; 95% CI: 4.23–251), a rapid response team (OR = 35.5; 95% CI: 3.00–776), care staff (OR = 37.3; 95% CI: 3.45–611), monitoring staff (OR = 244; 95% CI: 3.49–50,932), an isolation site (OR = 8.28; 95% CI: 1.78–49.5), adapted equipment (OR = 18.5; 95% CI: 3.79–123), and care guides (OR = 86.2; 95% CI: 11.4–1242) were strongly associated with the success of the response to Mpox.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe success of the Mpox response in Guinea relies on a functional and multisectoral organization. To ensure the sustainability of these gains, it is crucial to strengthen the coordination teams and regularly update the normative documents related to care and surveillance.\u003c/p\u003e","manuscriptTitle":"Success factors in the response to the Mpox epidemic in Guinea","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 09:02:34","doi":"10.21203/rs.3.rs-7151834/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"804f3279-cbf5-4188-9453-9be12f4e6fbf","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":51712635,"name":"Epidemiology"},{"id":51712636,"name":"Statistical Epidemiology"},{"id":51712637,"name":"Operations Research"}],"tags":[],"updatedAt":"2025-07-31T09:02:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-31 09:02:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7151834","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7151834","identity":"rs-7151834","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}